銀髮族咀嚼初篩與照護良策

Chewing Screen and Interventions for Older Adults

銀髮族入住安養機構最為人們詬病的是看到鼻胃管林立，以鼻胃管餵食銀髮族不僅是食物色、香、味覺的剝奪，也會造成營養不良和吸入性肺炎。研究發現長期照護機構鼻胃管留置的住民高達43％，其中不少鼻胃管留置的住民有顯著的營養不良及水分攝取較所需的少及身體質量指數、血中白蛋白下降情形。因為老化、牙齒缺損或中風導致長者發生吞嚥咀嚼障礙的盛行率高達60％以上，他們多以流質食物為生，而易缺乏纖維、蔬果和五穀類的攝取，引發許多健康問題，例如缺少植物類黃酮造成慢性發炎。本文旨在介紹銀髮族咀嚼篩檢、機能飲食的選擇及製備、活躍老化的餐前運動、咀嚼吞嚥照護及成效評值|期望未來跨領域的長期照護工作人員，協力合作以改善長照機構住民的口腔、咀嚼、吞嚥訓練與照護模式，提升銀髮族進食的輔具與環境、進食的選擇及滿意度|避免不必要的鼻胃管留置，以減少吸入性肺炎的發生，全面增進銀髮族的身心健康。

Seeing older adults with nasogastric (NG) tubes in nursing homes is an unfortunately widespread phenomenon in Taiwan. NG tubes deprive the wearer of the tastes, smells, and joys of food and have been associated with malnutrition and increased susceptibility to aspiration pneumonia. In our studies, we found that 43% of nursing home residents in Taiwan are intubated with an NG tube and revealed a significant lower body mass index and hypoalbuminemia in these residents. In addition, the prevalence of dysphagia in residents of long-term care institutions was found to be greater than 60%. Older adults with dysphagia usually rely on liquid diets, which are frequently low in fiber, fruit, vegetable, and cereal contents. It is well known that diets low in fiber and vegetables increase the risks of constipation and cardiovascular events in older adults. A low intake of plant flavanols may also make older adults more susceptible to chronic inflammation. A high intake of red meats, eggs, or seafood may nurture gut microorganisms that catabolize carnitine and choline to trimethylamine-N oxide and which have been significantly linked to cardiovascular diseases and increased mortality. In contrast, eating plant vegetables and cereals is known to nurture better microbiota that produce short chain fatty acids, which, in turn, nurture enterocytes and improve immunity and brain health. Thus, the aims of this article are to demonstrate how to assess elders with chewing difficulty and dysphagia and to provide functional food scales for the classification, training, and care of active-aging nutrition. Through this article, we anticipate helping long-term care caregivers master key techniques for training and caring for elders with chewing difficulties and/or dysphagia. This article is also expected to 1) improve the nutrition of elders and satisfaction with feeding, 2) improve chewing and dysphagia care and training in long-term care institutions, and 3) avoid NG tube institution and aspiration pneumonia. The suggestions of this article may be used in the future to assist long-term care units across the interdisciplinary care providers teams to promote chewing instruction, swallowing care training, and active aging, appropriate nutrition, and health in older adult populations.